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Ovarian masses are common in women. Also called tumors or cysts, these masses can either be benign (non-cancerous) or malignant (cancerous). Following are several types of benign ovarian masses
Several types of cysts fall into the category of functional cysts. These include follicular cysts, corpus luteum cysts, and theca lutein cysts. They are all benign and usually do not require surgery. All these cysts respond to hormonal stimulation.
The most common functional cyst is the follicular cyst. Follicular cysts are usually found accidentally on pelvic exams. Occasionally they rupture and cause abdominal pain. As long as these cysts are less than 8 centimeters in diameter no intervention is necessary. Usually they resolve spontaneously in one to two months.
Corpus luteum cysts are cystic structures that form from the corpus luteum (the part of the follicle that is left after ovulation and that produces progesterone). Corpus luteum cysts often cause delayed menses due to progesterone production. They may leak blood and cause pain. Corpus luteum cysts may be mistaken for an ectopic pregnancy if a woman is pregnant
Theca lutein cysts are bilateral cysts that often occur with molar pregnancies. They may also appear with ovulation induction. Theca lutein cysts may become extremely large, but usually regress spontaneously.
Tubo-ovarian abscesses are inflammatory masses sometimes seen in the abdominal cavity. These are pockets of infection that occur around the ovaries. Tubo-ovarian abscesses are usually the result of severe pelvic inflammatory disease (PID). Initial treatment consists of broad-spectrum antibiotic therapy in the hospital. If the masses persist despite antibiotic therapy–and if the woman is having high fever–drainage of the abscesses may be indicated. Your physician may do this by placing a needle into the pocket of pus with CT guided drainage, or may recommend surgery to remove the infection. If surgery is necessary, many women have to undergo hysterectomy to adequately remove the infection.
Women with endometriosis may form ovarian masses. Endometriomas are pockets of endometriosis that develop on the ovaries. They are sometimes called “chocolate cysts” because of the dark chocolate-like fluid inside them. They often can grow to about 6 to 8 centimeters. Endometriomas may be considered if a woman with a history of endometriosis or cyclic pelvic pain comes to her physician with a pelvic mass that is persistent over several months. Treatment is surgical removal of the cyst.
Benign cystic teratomas (also known as dermoid cysts) are common lesions seen in reproductive age women. The median age of occurrence is around 30 years old. A significant number of women who undergo surgery for an ovarian mass have a benign cystic teratoma. Multiple elements may be present within these cysts including hair, teeth, and fat. These elements form from the same embryological structure. Very few of these tumors are cancerous. These cysts have a high incidence of ovarian torsion, approaching 15%. Ovarian torsion is when the ovary twists on itself, therefore blocking its own blood supply. Often tissue death results from lack of oxygenation. The risk of torsion is high with dermoid cysts because of their high fat content, which allows them to float in the pelvic cavity. Treatment of a benign cystic teratoma involves removing the cyst surgically. Sometimes the ovary must be removed as well.
Epithelial tumors are tumors that increase in risk with age. Common benign tumors include serous cystadenomas, mucinous cystadenomas (which may become very large), fibromas, Brenner’s tumors, etc. Many of these tumors present as large, persistent masses. Treatment involves surgical removal. If a malignant lesion is noted at the time of the surgery, an oncologist should be available to assist.
Indu S. Anand, MD.
Dr. Anand is a former Assistant Professor in the Department of Obstetrics and Gynecology at the University of Tennessee Health Science Center, in Memphis, Tennessee. She now is in private practice in Atlanta, GA.
*The recommendations and information provided by this Web site are for educational purposes only. This Web site does not contain comprehensive coverage of the topics addressed, and is not a substitute for direct consultation with your health care provider. Always consult a health care provider regarding your specific condition. Trademarks referred to are the property of their respective owners.
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